The AMCNO has submitted comments to the State Medical Board of Ohio (SMBO) concerning their proposed amendments to Ohio Administrative Code Rules 4731-11-01, 4731-11-02 and 4731-11-13, which outline requirements for prescribing opiates for acute pain.

In the comments sent to the SMBO, the AMCNO expressed concerns about several key points, including necessitating the inclusion of an ICD-10 code on a prescription, as it could have an impact on patient privacy. Although it is understood that the requirement is intended to have the code for every controlled substance entered into OARRS by a pharmacist, the AMCNO wants to know how the information would be used and who is allowed to access the patient’s confidential information.

Also of concern is that some electronic medical records do not readily allow diagnosis codes or a diagnosis printed on a script, and changing systems to do so would be expensive and complicated. Regardless of whether systems allow it, the requirement would take more time away from patient care.

New rule 4731-11-13 states that extended-release or long-acting opioid analgesics shall not be prescribed for the treatment of acute pain. The AMCNO stated in its comments to the SMBO that the use of these medications should be left up to the prescribing physician. The new rule provides no option for physicians when prescribing for pain.

The rule also indicates that a3-day or less supply is usually sufficient, which does not apply to all clinical situations, and is even contrary to what is actually written into the rule. Also proposed is that if a physician believes that a prescription has to be extended for more than 5 or 7 days, the chart must show why that is necessary and why it is appropriate. It is not clear what would meet the definition of “appropriate documentation”—the SMBO would need to clearly define, either through regulation or education, what needs to be included in the medical record documentation.

Another section of the new rule limits a prescription for opioid analgesics for the treatment of acute pain at 30 morphine equivalent doses (MED) per day, without exception. There likely will be clinical situations in which this limit would have to be exceeded, so there needs to be an exception in the rule that allows for these types of situations. Also, the AMCNO questions how OARRS will be queried for this type of information as well as if and how physicians would be “investigated” if they exceed the limit.

In the AMCNO’s final comments, it was stated that data show physicians have been doing their part to curb doctor shopping and overprescribing. The AMCNO believes that focused data collection and analysis would allow the SMBO to concentrate on the physicians who need attention.

The AMCNO will continue to follow this issue and provide an updated report to members.